The market for dental implants and prostheses - France

1.2 The global market

The global market for dental implants and prostheses is expected to expand at a CAGR of *.*% over the period ****-****. From an estimated $*.** billion in ****, the global market is expected to reach $*.** billion by ****.

Estimated growth in the global market for dental implants and prostheses World, ****-****, billions of dollars Source: ****

this positive trend can be explained by a number of factors:

The aging of the population in developed countries: there were **.* million elderly people in ****, and this number is expected to rise to *** million by ****. Dental problems are more common in older populations. The growth in disposable income of the majority of the population, who can now afford dentures. Theincrease in the number of cases of dental caries, which is also linked to the new eating habits that people are gradually adopting. Therise of the cosmetics industry, which is developing a series of new techniques to improve the aesthetic appearance of braces, making the product more attractive. Finally, the context of globalization, which has created the opportunity for the lower classes in developed countries to access dental care in emerging countries at more affordable prices. This is known as "dental tourism".

North American domination of the global market

Geographical breakdown ...

1.3 The domestic market

Medical, surgical and dental equipment manufacturing market

Trend in CNAE code **.**A - "Manufacture of medical, surgical and dental equipment" France, ****-****, in billions of euros Source : INSEE The market for the manufacture of medical, surgical and dental equipment will total *.** billion euros in ****, enjoying stable and continuous growth since **** despite a slight downturn linked to the pandemic in ****. The average annual growth rate for the period ****-**** is *.**%. So, although the manufacture of medical-surgical equipment is a broader scope than that of dental implants and prostheses alone, it bears witness to the growth of this market over the last decade.

Dental prostheses market

Sales of the dental prostheses market France, ****-****, in billions of euros Source: information-dentaire.fr, UNPDD, OPCOEP Despite rising demand, sales of dental prostheses remained stable between **** and ****.

The fastest-growing segment is Computer-Aided Design (***), which rose from *% to **% of the market between **** and ****.

Challenges facing the French market

The Covid-** pandemic had a significant impact on the dental implant market. Indeed, the two periods of confinement (***) led many patients to postpone non-urgent care, especially dental treatment. However, since these treatments were postponed and not cancelled, there was a catch-up mechanism in the market in **** and **** .

What's more, ...

1.4 Imports and exports

HS.****** : Dental appliances; artificial teeth. HS.******: Dental appliances, other than artificial teeth, thus including dental implants.

Imports and exports HS code ****** France, ****-****, millions of euros Source: ****

Between **** and ****, French imports of dental prostheses and artificial teeth rose significantly, from **.* billion to **.** billion. At the same time, exports also increased, albeit less markedly, rising from *.** billion in **** to *.** billion in ****. As a result, the trade balance remained negative throughout this period, worsening from -**.** billion in **** to -**.** billion in ****.

French HS export destinations: ****** France and the World, ****, % (***) Source: ****

In ****, French exports of dental prostheses and artificial teeth were split between several destinations. The USA was the main market, accounting for **.**% of exports, followed by Spain (***). The rest of the world accounted for **.**% of French exports in this sector.

Origin of French imports: HS ****** France and the rest of the world, ****, in % Source: ****

French imports of dental prostheses and artificial teeth in the same year came mainly from Germany and Turkey. Germany and Turkey accounted for **.**% and **.**% respectively, followed by China (***). The rest of the world accounted for *.**% of imports.

Imports and exports HS code ****** France, ****-****, millions of euros Source: ****

With regard to trade in dental implants, imports rose from ...

2.1 Population and demographics

Global demographics

The United Nations predicts that by ****, the number of elderly people (***) in the world will have doubled, from *** million in **** to *.* billion. Their share of the world's population would thus increase from *,* % à **,* %.

An ageing population: already a reality...

Proportion of French population aged ** or over France, ****-****, in % Source: ****

...which will continue to be a growth driver for the future of the sector

Population projections to **** in millions of inhabitants, France, ****-****, as a % of total population Source: CNSA (***) based on INSEE The aging of the French population is real, as this graph shows. While thoseaged ** and over willrepresent only *.*% of the population in ****, their weight in the French population will double to **.*% in ****. This aging is linked to longer life expectancy and the arrival of the baby-boom generation at retirement age: * factors favoring the number of potential consumers for dental implants and prostheses.

2.2 Segmentation of demand for implants, prostheses and dental care

Demand can be analyzed from two angles:

Demand from end-consumers, i.e. patients on whom implants or appliances are placed (***). Demand from dental surgeons in charge of operations (***).

Patient demand for dental care

Dental care consumption comprises all fees paid to dentists, whether for conservative care (***) or dental prostheses. This indicator shows the trend in demand from individuals for dental care and, by extension, demand for dental implants.

Dental care consumption reached **.* billion euros in ****, including **.* billion euros in fees, up **.*% in value terms on the previous year.

Dental care consumption France, ****-****, in billions of euros Source: ****

dental care and prosthetics are by far the largest components of dental care expenditure (***). Breakdown of dental care consumption France, ****, in Source: ****

Logically, practitioners and patients do not pay the same attention to the same criteria when choosing their implant brand or product. However, practitioners must certainly take into account what their patients want, to avoid losing them to the competition.

What criteria are important to your patients when it comes to implant-supported prostheses? France, ****, in Source: ****

Patients are particularly attentive to efficacy, which is of decisive importance for **% of them. They therefore want a reliable device that they won't need to change ...

2.3 Demand trends and developments

Reimbursement for dental prostheses

Overall, the high price of dental implants and prostheses in France, combined with low reimbursement levels, is holding back the development of this market.

For example, the graph below shows the difference in price for a complete dental implant (***) depending on the country chosen. As previously announced, France offers an average price of *,*** euros, the highest with Belgium, and double the average price in Romania.

Average price of a complete dental implant by country Europe, ****, in € Source: ****

The ***% healthcare reform

Demand for dental prostheses from manufacturers is indirectly linked to their reimbursement by Social Security. The higher the reimbursement, the more patients can afford to buy dentures.

Since January *, ****, the French Ministry of Health hasbeen offering all French people with a supplementary health insurance plan (***) access to ***% reimbursement for optical, hearing and dental care.

Before the reform, the average price of a ceramic crown was €***. After reimbursement of €*** by the Assurance Maladie and the complementary health insurance, the insured would still have to pay around €***.From January *, ****, prosthesis prices will be capped and included in the ***% Santé basket, with no out-of-pocket expenses for the policyholder.

This decision can be seen to have had the following impact on ...

3.1 Market dynamics

Dental implant market value chain

Implant manufacturers are mainly medical device companies. The global market is fairly concentrated, with four major companies - Straumann, Danaher, Dentsply Sirona and Zimmer-Biomet - controlling over **% of total production. In France, the most popular dental implant brands are Nobel Biocare, Zimmer, Straumann, Dentsply Sirona and Global D (***).

The dental implant market is a B*B market for dental professionals. TheStraumann example seen above gives a relatively precise idea of the customers of dental implant manufacturers, and therefore of the constitution of the rest of the value chain. Indeed, we have seen that by ****, **% of Straumann's sales will be generated by dental practitioners.

Denture market value chain

Dentures, though related to dental implants, have a different value chain. The * main players involved are as follows:

Laboratories, companies or groups of varying sizes, manufacture the prostheses. Dental technicians work directly in the laboratories. Dentists are in direct contact with patients.

Formerly known as "dental mechanics" until ****, dental technicians gradually separated from dentists to become independent professionals. European Directive **/**/EC of June **, ****, on custom-made medical devices, granted them the status of manufacturers in their own right.

To combat competition from foreign dental prosthetists and production by dental players, ...

3.2 Production

Dental implant manufacturing

Materials used to manufacture dental implants

Dental implants are screws used to replace missing teeth. Since they are implanted directly into the patient's bone, implants must be biocompatible to ensure that the patient does not react badly to the introduction of this foreign organism. The materials used in their manufacture are as follows:

Titanium: the most commonly used material. Zirconium : this appears to be a valid alternative, providing better aesthetics, but is still undergoing experimentation as it is less elastic and therefore more susceptible to microfractures.

Another aspect that weighs in the balance is price: a titanium implant costs between €*** and €*,***, compared with an average of €*,*** for a zirconium implant.

Comparison of implant prices by material, France, ****

Source: ****

The manufacture of a dental implant is almost entirely done by machine. A long titanium rod, which can be used to manufacture several hundred implants, is passed through a machine to be cut, threaded and shaped. [***]. Various treatments (***) can then be applied to the surface of the implants to increase the chances of successful placement.

Different types of implant

Dental implants are classified into * categories according to size and shape.

Theclassic implant is used in over **% of cases. This conical-shaped ...

3.3 Production challenges

Every year in France, around **% of dentures fitted come from abroad. The vast majority (***) are designed directly in France. Indeed, according to the UNPPD, even if importing prostheses reduces costs, it raises concerns about their quality and traceability.

Let's look at the evolution of national production through the number of companies and employees in NAF code **.*A dedicated to "Manufacture of medical and dental instruments and supplies".between **** and ****, the number of companies in this sector fell by around *.*% over the period studied, while the number of employees in the companies rose by *.*%, from ***** in **** to ***** in ****.

This increase in headcount, combined with a decrease in the number of companies, demonstrates a concentration of the sector over this period, and surely a decline in competitiveness.

Number of companies and employees in NAF code ***A: "Manufacture of medical and dental instruments and supplies" France, ****-****, in units Source: ****

Source: ****

4.1 Offer typology

The table opposite shows the different types of implants available:

Source: ****

Dentures can be either complete, when they replace all the teeth in an arch, or partial, when they replace only some of the teeth. The table below shows their main characteristics:

4.2 Prices

First of all, it's important to remember that an implant is used to screw in a false tooth, the crown, and also requires the installation of the abutment, which connects the two elements. So, in reality, buying an implant also means buying a crown and an abutment, which considerably increases the total price. Nevertheless, the implant is often the most expensive of the three. On average, dental technicians charge the following prices for a titanium implant:

source : Dentaly Furthermore, the Cour des Comptes, in a **** report, explained that the average purchase cost of a ceramic-metal crown was €*** from a dental technician. The margin therefore varies between €*** and €*,***. Thus, the average total cost invoiced in France for a complete implant is between €*,*** and €*,***, with an average around €*,***. Another source estimates the average total cost of the operation at €*,***. [***]. As for dentures, the price fluctuates according to the type and materials used. Here is a table summarizing the usual prices for dentures: Type of denture Current price Single dental implant between €*** and €*,*** Abutment between €*** and €*** Ceramic dental crown between €*** and €**** Metal or metal-ceramic dental crown between €*** and €*,*** Ceramic dental crown between €*** and €*,*** Inlay-core dental prosthesis (***) between €*** and €*** Removable denture (***) between €*,*** and €*,*** Partial removable ...

4.3 Supply trends

Owandy Radiology defines the dental CAD/CAM chain (***) of a customized medical device. It therefore concerns all dentistry specialties involving custom-made medical devices.

Representation of a complete dental chain

Source: ****

The arrival of CAD (***) in the field of dental implants and prostheses represents a new supply trend in the dental market due to several key advantages:

Increased precision and improved quality of care : CAD/CAM enables precise design and planning of dental implants and prostheses using digital data, reducing human error and ensuring optimal fit. As a result, CAD/CAM delivers longer-lasting, more satisfying results for patients. Customization: thanks to CAD/CAM, implants and prostheses can be customized for each patient's specific morphology and needs, enhancing the comfort and aesthetics of treatment. Efficiency and speed : the digital design and manufacturing process is faster than traditional methods, reducing lead times and waiting times for patients. CAD/CAM, for example, can produce a crown in barely an hour. [***] Integration with digital dentistry: CAD/CAM integrates seamlessly with other digital dental technologies, enabling comprehensive planning and a more holistic approach to dental treatment. Long-term cost reduction : Although initial investment in CAD/CAM equipment can be significant, this technology can reduce long-term costs by minimizing ...

5.1 Regulations applicable to the dental implant and prosthesis markets

In France, the regulations governing dental implants and dentures are not exactly the same, although both are governed by laws and standards designed to ensure their quality, safety and efficacy.

Dental implants are considered active implantable medical devices, whereas dentures are considered custom-made medical devices, designed specifically for a patient.

The FrenchNational Agency for the Safety of Medicines and Health Products (***) provides regulatory information on each medical device. [***]

Common regulations for medical devices

CE marking: implants and prostheses must be manufactured in compliance with the safety and performance requirements defined by European directives on medical devices. They must bear the CE mark, attesting to their compliance with European standards. Traceability: devices must be properly identified and traceable throughout their life cycle.

Implant regulations

Certification: manufacturers of dental implants must be certified to ISO *****, which sets out the requirements for quality management systems for medical devices. Marketing authorization (***) : before being marketed in France, dental implants must obtain a marketing authorization issued by the ANSM. Post-marketing surveillance : once their implants are on the market, manufacturers are required to monitor their products and report any undesirable effects or major incidents to the ANSM.

Regulations governing implants

Medical prescription : the manufacture of a dental prosthesis ...

5.2 The new dental agreement: a break with the past

from ****, a new dental agreement comes into force for a period of * years. It aims to limit patients abandoning care for financial reasons. It also adds and removes new CCAM codes to adapt to new healthcare products.

L'UNPPDregrets, for example, the creation of "pseudo-technical" labels, which encourage the development of low-cost prostheses. However, the association has succeeded in getting dental surgeons to give patients a document containing the name and address of the prosthesis manufacturer.

Conservative care has been upgraded, to the detriment of dentures, in an effort to prioritize prevention and dental care.

Source: ****

With regard to prosthetics, the reform introduces tariff ceilings and distinguishes * new baskets of prosthetic care, as explained above. These new regulations, which prioritize care over prosthetics via new fee schedules, could diminish dental surgeons' interest in French prosthetics, which are too expensive and no longer profitable enough.

6.1 Segmentation

Dental implant segmentation

Dental prosthetics segmentation

• Straumann
• Dentsply Sirona France
• Zimmer Biomet Dental France
• Osstem Implant
• Biotech Dental
• Anthogyr
• Lyra Dental
• Global D
• Danaher
• Nobel Biocare (Groupe Envista)
• Protilab
• Labocast
• Yuwei Dental
• CPLD Midi-Pyrénées
• Bego
• OsteoCare Implant System Ltd
• Aon Implants
• Implants Diffusion International (IDI)
• Dio Implant
• Henry Schein Group
• TBR Dental Group
• PODO 3D
• Envista
• Ubgen